Guest Post: Sexual Assault By a Medical Provider Is Not a Big Deal… Until It Is

The following is a first-hand account of mistreatment on several levels at the hands of a medical provider via Ania of Scribbles and Rants, a blog where she, along with her partner Alex, sheds insight onto matters as diverse as skepticism, feminism, disability, and the relationship between being an atheist and a person of color. I had the pleasure of meeting her at Eschaton last year and was impressed with her courage, passion, and intellect. I am even more impressed now.

When I was 18, I was assaulted by a doctor at the university clinic.

I had gone in to get tested for bacterial vaginosis. I was in love and wanted to make sure that I didn’t smell strange if the chance to have sex ever came up. The first doctor at the clinic was very kind. She opted not to use a speculum since I was a virgin, just like every other doctor I had seen for a vaginal issue until that point. I got a call a few weeks later to come in to get my results. The doctor who saw me then was someone I had not seen before. Before she even got to the test results, she began laying into me about my weight. She told me I was morbidly obese, that diabetes must be causing the smell. I was maybe 40 lbs. heavier than my optimal weight for my height. I didn’t know what fat shaming was then, but I tried standing up for myself, letting her know that my cholesterol, blood pressure, and blood sugar levels were all perfect.

The facts didn’t matter to her. She had decided that I didn’t meet her standards of fitness and that the best way to deal with it was to make me feel horrible about myself. Finally, we got to the results: I did not have BV. She asked me why I had come in to check on it, and so I told her. Unexpectedly, she offered to take a look. I was shocked, but I accepted her offer. I was worried and she was a doctor. She had to be professional, right?

As I sat on the table, getting ready for the exam, I looked over at her and asked her not to use the speculum. I was a virgin, I told her, and the other doctor said it wasn’t necessary. Then, I lay down on the cold table. There is vulnerability in that statement. Everything about the doctor’s office is about power. You sit, while the doctor stands above you. You are naked, while they are dressed. You are in pain, afraid, vulnerable, and they hold the answers. Everything about the doctor-patient relationship reinforces that power dynamic. I was vulnerable on that table, exposing my private parts to a doctor who had already wounded me. She had already established her power over me, so I knew that my request was a supplication. It was her power to grant it.

But she didn’t.

As I lay there exposed on the cold table, worried about whether or not I was normal, the doctor violated my request. She shoved an unlubricated speculum inside me and opened it to its widest setting. I can’t even remember what came next. I do remember the pain. I don’t remember walking out of the clinic. I do remember trying to rush back to my dorm; I didn’t want to cry in public. I looked for the room of the person I trusted most on campus but he wasn’t home. In my search for him, I ended up in a room with some people I vaguely knew. I broke down crying. I told them what had happened. I was bleeding, I was sure of it. I felt torn. But I was crying about the fat shaming, had every instance of it having happened flying through my brain.

I was lucky in some ways. The people I barely knew, who comforted me as I cried, said all the right things. They told me what happened wasn’t my fault. That what she had done was wrong and that I was right to be upset. Not everyone is so lucky. But I didn’t want to listen. I wasn’t prepared to face that what happened to me was assault, so instead, I concentrated on the fat shaming. I convinced myself that the assault was no big deal.

Years later, when I lost my virginity, I postponed getting a pap smear for two years. Normally, you are expected and encouraged to get one within a year of becoming sexually active, but I didn’t want to be in that vulnerable position again. Moreover, I became more sensitive to fat shaming. I lost my temper more quickly whenever my weight was mentioned. It tinged all my interactions with doctors. If they brought up my weight, I found it more difficult to trust them or found myself reacting negatively to the rest of the appointment. Every time a doctor failed to listen to me, it felt like another betrayal.

Everything came to a head when my GI made the decision to send me to the weight management clinic. The morning of the appointment, I woke up in a panic. My heart was beating like crazy. I was sweating. I couldn’t focus my mind. I found myself sitting in a corner, rocking back and forth and crying. I couldn’t understand why.

All I could think about was that doctor, her cold hands, the pain of the rough plastic edges as the speculum entered me, the stretching-tearing feeling of it being opened. I couldn’t get the feeling of betrayal, of being violated, out of my mind. Superimposed over those feelings was every instance when a doctor refused to listen to me, all the times when I’d had to be vulnerable with a doctor and had that vulnerability rewarded with pain and betrayal.

When I realized what was going on — a panic attack — I took some anxiety medication and tried to calm myself down. I spent my day curled around myself, trying to hold myself together, as I watched the clock tick down to my appointment. I was terrified. I didn’t know what would happen when I went into the clinic.

Throughout my struggle, I realized that what I had thought was no big deal had actually been affecting my interaction with doctors for years. Suddenly, I was facing the truth: What had happened to me was a big fucking deal. I had been assaulted. By a doctor. By a member of society that I was supposed to be able to trust implicitly. By a person that everyone expected me to trust. Not only had my body been violated, so had my ability to trust that doctors had my best interest at heart. What’s more, the violation brought on the realization that I was very much a member of a vulnerable population: people with disabilities are among some of the most at risk for sexual assault.

Sexual assault is about power. It is about the perpetrator feeling like they have power over the victim. It is not about sex. The inclusion of my genitals in this assault was incidental. The doctor in question wasn’t trying to get any kind of sexual thrill or fulfill a sexual desire. Who I was didn’t matter. She just needed to assert her own power over someone else, and I was the lucky victim.

If you asked her, she probably would have no idea that what she did to me was assault. She might make excuses about how she thought that the use of a speculum was necessary. She might say that she is a doctor and I am not, and that she knew better than I did. It doesn’t matter what she would say. The simple truth is that I made my boundaries clear and she violated them. The fact that she did so without even the courtesy of using lubrication (standard in those types of medical procedures) is just icing on the cake. To her, it didn’t matter if I felt pain. I wasn’t a human being in that moment. I was at her mercy. She was the one in charge and she could do whatever she wanted to me without fear of consequences. To her, what I wanted didn’t matter. And that is what makes it assault.

Assaults by doctors, unless sensationalized and existing on a large scale, rarely get talked about — and are sometimes even trivialized. We as a society put great faith in doctors. We don’t want to face that the people responsible for our health and well-being might be as human as the rest of us. We don’t want to address the fact that power dynamics that are enforced as severely as those between patients and doctors puts everyone at risk of abuse. We especially don’t want to talk about doctor abuse, because in doing so, we risk being lumped in with conspiracy theorists that take things too far and condemn the medical profession altogether. As an advocate of evidence-based medicine, it’s difficult to draw attention to abuses perpetuated by doctors and still defend medicine as a profession.

And yet, drawing attention to this abuse is very important. When someone is hurt so personally by a doctor, it can be easy to lose faith in the entire industry. Being violated by a doctor does more than affect you psychologically, it can also put your health at risk. It can make you afraid to be vulnerable with doctors again. It might mean that you try to protect yourself by keeping things to yourself that the doctor should know about. But more importantly, talking about doctor abuse is essential to help victims know that they didn’t do anything wrong and that they are not alone.

Whenever I discuss what happened to me, someone always feels the need to mention that the doctor might not have been thinking about consent but might have simply decided that using a speculum was necessary. Who was I, as an untrained patient, to decide what equipment the doctor needed or didn’t need, they ask? I have questions of my own. If doctors know better, does that mean they have the right to ignore the boundaries I set for myself? Does that mean that I have no say in what happens to my body? And if so, is my body really mine? What about your body? And where do we draw the line?

Heina Dadabhoy [hee-na dad-uh-boy] spent her childhood as a practicing Muslim who never in her right mind would have believed that she would grow up to be an atheist feminist secular humanist, or, in other words, a Skepchick. She has been an active participant in atheist organizations and events in and around Orange County, CA since 2007. She is currently writing A Skeptic's Guide to Islam. You can follow her on Facebook, Twitter, or Google+.

11 Comments

There are very narrow sets of circumstances where the patient is not the final decider of *any* treatment and patient consent is overriden. This was nowhere near one of them and damn anyone who says otherwise.

Something similar happened to me two years ago. An OBGYN performed two invasive procedures without my consent, and the rest she did without explaining to me. Then my bad luck got worse and the tests she did resulted in a misdiagnosis, which she insisted was correct. She said I didn’t want to accept the consequences of my “actions” (having sex with more than one person in my life) when I questioned it. Thankfully the two OBGYNs I saw to clear things up and confirm there was nothing wrong with me. But it was a horrible experience that I still think about. I filed a complaint with the state but after I went through the process I realized that few of those ever come to anything. If I could go back in time I would have consulted with a lawyer.

These days am very careful who I see for OBGYN-related issues. I look for doctors affiliated with a reliable hospital. The doctor who violated me was not, which meant avenues of complaint were smaller.

I could probably write my own post about slut-shaming gynos. I had one who assumed I wasn’t in a relationship at all when I told her I’d had sex with more than one person since I’d seen her, and that I was being pressured to “not commit” (i.e. be nonmonogamous, which in her eyes meant a lack of commitment) by my male partner.

Unfortunately this experience is not uncommon and I think it’s important for women to keep this dialogue open about medical abuse and consent. By examining women’s relationship with medical hegemony we can see how routine vaginal exams have been absorbed into mainstream thinking about how women’s bodies should be cared for. Women told they are expected to submit to regular pap smears, and the language used by medical staff, by advertising and media, and by other women is often forceful and paternalistic, “you should”, “you must” and “you have to” or “all women must do this” there is no exception. Women who decline this testing are chastised like children and shamed for not looking after their vaginal health. Many women who express a feeling violation over this routine test are told to “grow up” and “get used to it” because “this is part of being a women”.

What’s interesting in all this is when you do your homework, you discover that getting a pap smear is about as necessary as getting a regular brain scan. Pap smears only look for abnormalities on the cervix, and while there’s a small benefit to detecting and treating abnormal changes on the cervix – just in case it may develop into cervical cancer, the risks IMO are far more prevalent. Studies have concluded that over diagnosis and unnecessary treatment for benign cellular changes exceed the number of women who would actually go onto develop cervical cancer; this cancer is rare and always has been. But many women have been scared both emotionally and physically by the just in case it develops into a rare cancer treatment that can cause cervical scaring which can effect fertility, difficulties with pregnancy and birth, and cervical stenosis.

There is a different language for men when applied to routine screening of prostate and testicular cancer; men are not told they “must”, they are given the risks and benefits and then a choice, and they are allowed to say no. When women say “no” we either get a direct order to comply or a polite “yes but…” women’s agency is not being respected. Informed consent is often missing in a medical setting and many women are unaware of their right to refuse this screening. In addition to the misinformation being touted by well meaning screening campaigns, it’s understandable that women believe that vaginal exams are a part of being a woman. It’s really not.

So, some sourced data: According to the CDC (http://www.cdc.gov/cancer/cervical/statistics/), cervical cancer used to be the top cancer killer in women. Due largely to the promotion of Pap smears, it is not anymore. Hopefully HPV vaccines will make the cancer itself rare, but we’re very much not there yet. It is a cancer that is typically slow to develop, which makes screening ideal, but it is not easy to treat. About a third of those diagnosed with cervical cancer in 2010 died from the disease. (http://www.cdc.gov/cancer/cervical/statistics/)
As for treatment, there is some discussion about the best way to deal early-stage dysplasia. (http://www.ncbi.nlm.nih.gov/pubmed/9487318) However, the NIH currently recommends monitoring, by further Pap smear, in mild cases. (http://www.nlm.nih.gov/medlineplus/ency/article/001491.htm) Colposcopy–stain and magnification of the cervix to determine the extent of abnormal cells–is not much more invasive than a Pap, though it is frequently accompanied by biopsies where there is extensive abnormality. Colposcopy, even with biopsy, does not contain the risks you speak of. (http://www.mayoclinic.com/health/colposcopy/MY00236/DSECTION=risks) Those risks only come with surgical removal of a patch of abnormal cells, or as I called it when I had it done, resurfacing of the cervix. That is only recommended after colposcopy and biopsy find moderate to severe abnormalities.
Also, if you follow all those links I provided, you’ll see that all the recommendations are presented as recommendations. I agree that information like that should not be presented as demands. I disagree, however, that this is standard practice these days.

I also disagree. As mentioned previously, cervical cancer used to be a leading cause of cancer death in American women. (Cervical Cancer killed Henrietta Lacks.) It is still a leading cause of cancer death for women in developing countries. These women typically have either totally lack or have limited access to pap smears. It also tends to strike younger women, so screening programs are more likely to extend a woman’s life.

As for the argument that pap smears identify abnormal cells not cancer and that there are more positive pap tests than predicted cases of Cervical Cancer, that is precisely the point. Cancers start as abnormal cells. Not all abnormal cells will become cancer, but if you can find and remove abnormal cancer cells before they become cancer, you can prevent the cancer. You would, of course, expect to have more positives than predicted cancer cases in the absence of screening because you are detecting pre-cancerous cells, and we can’t necessarily predict which of those positives would develop cancer. The principle is similar to dermatologists’ removal of moles that have changed recently. The biopsy can show whether it’s skin cancer, but in many cases, even if it’s unlikely to be cancerous at this time, a dermatologist will recommend removal because it’s more likely to become cancerous and removing it is a pretty low-risk procedure. The pap smear probably reduced cervical cancer deaths by 70%, and a significant number of the deaths we today are a in women who didn’t have the test.

Are unnecessary screenings pushed on women? Certainly. Mammograms in women of normal breast cancer risk come to mind. But pap smears don’t fall into that category. Doctors should treat their patients with respect and recognize their autonomy, but they’re also human and if a patient explains she’s not interested in a pap smear because cervical cancer’s always been rare and they don’t actually prevent anything, that doctor is likely to argue with the patient and perhaps tell the patient that she’s wrong in a less than supportive manner. (Though the no refill on the birth control pills without a pap is not okay at all in my book.)

This sounds unfortunately so familiar to me and I hear it most often from my friends (women of childbearing age who have recently had babies.) OBs insisting on unnecessary cervical checks during pregnancy and during labor. Having procedures done to them they did not consent to like episiotomies. During the birth of my first child, the OB was poised to cut me until my doula saw her and asked if that’s what I wanted. Which I then said NO! Luckily she stopped, but without my advocate (who I hired to be there with me) I would have had no idea, no protection and NO consent. I felt scared, mistrustful of every single medical professional there and was reluctant to have another baby there. (I went on to find a certified nurse midwifery practice that recognized my apprehension and went on to have two other great experiences and I continue to see them for all my GYN needs.)
This is a topic that gets brushed under the rug, and I hope more women can see it for what is it. Assault. Instead of being told we are “crazy” and “sensitive” and “over reacting.”

I went to a gynecologist about a complaint and experienced severe pain when she swabbed me with a cotton swab. I was bent over double when I walked out of her office. I’d told her about my vaginal pain issues, and instead of offering information or even basic consideration she made fun of me for being hurt by a cotton swab.
I realize now that other women have the same problem, and that I should go to another doctor. But the humiliation was too much.

This happened to me at 12 years old in an ER. I went in with what ended up just being my first taste of horrible cramps, but my parents were worried that it was my appendix or something similar. The doctor decided to do a vaginal exam, but apparently couldn’t find anything except the largest size of speculum available. I could hear him talking about it with the nurse and he finally just said, “I’ll make it work” and shoved it in to me with no warning or lubrication. Again, I was 12. They could hear me screaming from the waiting room. To this day, almost 20 years later, I’ve never had a pap smear done by anyone but a midwife because I can’t stand the thought of feeling that level of pain again.

The writer uses the term assault or sexual assault, but that seems pretty definitively like full-on rape to my vocabulary. That doctor would go to fuckin’ prison, if our legal system wasn’t designed by Patriarchy McRapeculture.

I’ve been trying to get up the nerve to post for days. Ugh. So my first visit to the gyno was when I was 18. I was tired of my irregular periods and wanted to get on BC. As I’m sitting in the paper robe in the exam room, after waiting over an hour, the doctor finally comes in. She is abrupt through the whole exam, taking my pulse, asking if I was nervous, “Well, yes, this is my first gynocological exam.” And she laughed at me. I went back to her for several years, not knowing any better. I did not know that it was not normal to be in pain and bleeding for three days after a pap smear. Whenever I yelped during the exam, she always ignored me. I get skin infections, boils, around the underwear area, and one time she saw one that was healing and said “Does this hurt?” and stabbed it with her finger. Well, lady, it sure does now! I never felt like a human being, I felt like I was on an assembly line: swap one patient for the next, one vagina for the next, it’s only body parts, not people.

With my current doctor (that I put off going to for 3 years). I went and and said: look, I had a really bad experience. I’m super nervous, you need to go slowly and talk to me. I told her what happened, and she looked deeply concerned and said “As a doctor, it is generally my goal *not* to cause pain.” And she works with me and tries to keep me as comfortable as possible. I’ve never had any lasting pain or bleeding from her. I’m slowly learning that this doesn’t have to be traumatic.